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General NPI Number Information
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NPI Number | 1255848008
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Entity Type | Individual
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Provider Name | VANITA ANDREA BOWICK
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Gender | Female
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Dates
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Enumeration Date | 01/02/2018
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Last Update Date | 01/02/2018
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Provider Practice Location Address
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Address Line | 2121 HARRISON AVE APT G7
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City | PANAMA CITY
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State | FL
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Zip | 32405-4564
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Country | US
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Telephone | 850-688-5244
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Fax |
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Provider Business Mailing Address
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Address Line | 2121 HARRISON AVE APT G7
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City | PANAMA CITY
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State | FL
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Zip | 32405-4564
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Country | US
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Telephone | 850-688-5244
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 234759
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License Number State | FL
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